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Clarity on MBS billing for immunisations

14 Jun 2018

Last week saw incorrect advice provided through the Department of Human Services AskMBS line go viral, suggesting that GPs could not bill the MBS when administering a National Immunisation Program supplied vaccine.

While AMA President, Dr Tony Bartone, moved to quickly reassure GPs on social media that long-standing arrangements under the MBS had not changed, the AMA immediately asked the Department of Health to issue a statement to remove any doubt. In this regard, the advice issued by the Department is detailed below in italics:

Where a medical practitioner administers an injection for immunisation purposes on his or her own patient, Medicare benefits for that service would be payable on a consultation basis, that is, for the attendance at which the injection is given. However, the cost of the vaccine itself does not attract a Medicare rebate. The Medicare benefits arrangements cover only the professional component of the medical practitioner's service.

A number of examples were provided by the Department that further clarify the topic:

Example 1

A patient presents to a GP to receive the influenza vaccination. The patient is not in the cohort of patients which is covered for the influenza vaccine under the NIP.

After taking a short patient history, the GP administers the vaccine to the patient. The GP has met the requirements of a level A consultation and claims item 3. The GP can bulk bill the patient for the cost of the MBS service and can charge a separate amount for the cost of the vaccine, which is not covered under the NIP.

If a patient presented to a GP to receive a vaccine and to enquire about a medical condition, the GP may claim the appropriate item (such as item 23).

Example 2

A patient presents to a GP to receive the influenza vaccination. The patient is in the cohort of patients which is covered for the influenza vaccine under the NIP.

After taking a short patient history, the GP administers the vaccine to the patient. The GP has met the requirements of a level A consultation and claims item 3. The GP can bulk bill the patient but does not need to charge a separate amount for the cost of the vaccine, which is covered under the NIP.

If a patient presented to a GP to receive a vaccine and to enquire about a medical condition, the GP may claim the appropriate item (such as item 23).

Example 3

A GP is employed by a State or Territory community health centre to administer vaccines and provides no additional medical services.

A Medicare benefit is not payable as the GP is providing the service under an arrangement with the State or Territory, which is prohibited under subsection 19(2) of the Health Insurance Act 1973. The service is also prohibited on the basis that it is a mass immunisation which is prohibited under subsection 19(4).

The AMA remains concerned about the veracity of the advice being provided to health care professionals and will be raising this issue further with both Departments.